Qualitative Analysis of Point of Care Ambulatory Blood Pressure Monitoring: Patient, Parent, and Primary Care Provider Perspectives

Abstract

BACKGROUND:

Hypertension is undiagnosed in three-quarters of affected youth. Barriers include uncertainty about the accuracy of in-office blood pressure measurements, limited access to recommended confirmatory ambulatory blood pressure monitoring (ABPM), and low subspecialist referral completion rates. This study aimed to assess whether ‘point of care’ ABPM, ABPM device placement within the primary care setting, could improve HTN diagnosis confirmation.

METHODS:

This prospective cohort study was conducted within a single urban primary care practice. ‘Point of care’ ABPM was offered to youth 10 to 17 years of age with suspected hypertension based upon a single manual blood pressure ≥ 95th percentile. We conducted semi-structured qualitative interviews with patients, parents, and primary care providers to evaluate perceptions and experiences with ‘point of care’ ABPM, perceived barriers to device tolerability, confidence in results, and comfort with follow-up recommendations. Qualitative data were analyzed using an inductive thematic approach.

RESULTS:

‘Point of care’ ABPM was offered to 62 youth and accepted by 60 (97%). Qualitative interviews of patients (N=25), parents (N=24), and providers (N=8) revealed that parents recognized the benefit and convenience of ‘point of care’ ABPM and trusted the ABPM results. Parents and providers reported greater certainty in the diagnosis when they did not have to rely on in-office blood pressure assessment alone.

CONCLUSIONS:

ABPM may be an acceptable approach for improved hypertension diagnosis confirmation in children and adolescents when applied within the primary care setting. Further, it may help alleviate parent and provider uncertainty about the significance of elevated in-office blood pressure.

Graphical Abstract:

INTRODUCTION:

Hypertension (HTN) is prevalent in 4% of US children and adolescents.^{1, 2} The 2017 Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents defines a diagnosis of HTN as the average of 2–3 manual blood pressure measurements ≥ 95^th percentile if <13 years of age and ≥130/80mmHg if ≥ 13 years of age, taken over 2–3 in-office visits. The 2017 CPG also recommends confirming an HTN diagnosis via ambulatory blood pressure monitoring (ABPM) after the 2^nd or 3^rd in-office visit if the average in-office blood pressure is still elevated. However, challenges with this approach include low rates of follow-up for repeat in-office blood pressure assessment within the recommended timeframe^{3, 4}, provider uncertainty regarding the accuracy and significance of an in-office blood pressure measurement^{5, 6}, failure to complete all blood pressure measurement steps, and failure to perform ABPM or to complete recommended subspecialty referral visits.⁴ Only 2% of youth with elevated blood pressure levels undergo all recommended blood pressure assessments.^{4, 7}

ABPM is the gold standard for confirming an HTN diagnosis in US children and adolescents.⁸ ABPM is more reliable and reproducible than in-office blood pressure measurement.⁹ It can distinguish high in-office blood pressure due to the white coat effect from sustained HTN.^{10, 11} It is also the only test that can reliably diagnose masked HTN- normal in-office blood pressure but high out-of-office blood pressure.¹²

Despite its benefits, ABPM use is currently limited in the US. Access and time to referral to a subspecialist for device placement poses a significant barrier.¹² Access may be particularly challenging for children and adolescents within higher-deprivation communities.¹³ There is also a belief among many providers that children and adolescents do not tolerate ABPM.¹⁴ However, with further evidence to support the acceptability, feasibility, tolerance, and benefits of ABPM use, the cost and availability of ABPM could be positively influenced. Intervention strategies that leverage the primary care setting without burdening the site may offer greater compliance and completion of recommended confirmatory testing for HTN in children and adolescents, leading to enhanced HTN diagnosis and chronic disease management.¹⁵

To assess the potential for ‘point of care’ ABPM to improve HTN diagnosis confirmation in children and adolescents, we conducted a single-site, prospective, mixed-methods cohort study to assess the acceptability, feasibility, and tolerance of ABPM device placement within a pediatric primary care practice setting This manuscript reports results from qualitative interviews of participating patients, parents, and providers.

METHODS:

The 21-item SRQE (Standards for Reporting Qualitative Research) checklist was used to ensure transparency in this research.

Study Sample:

The study sample includes 60 children and adolescents, 10 to 17 years of age, who receive care within a primary care practice in Wilmington, DE. Patients were eligible for study participation if not previously diagnosed with HTN and if found to have an oscillometric blood pressure, followed by a manual blood pressure ≥ 95th percentile if 10–12 years of age, SBP ≥130mmHg or DBP ≥80mmHg if 13–17 years of age, at a single outpatient visit. We specifically chose a high-deprivation community practice (area deprivation index (ADI) of 93, national scale 1 to 100, low deprivation=1 and high deprivation =100; local scale 1 to 10, low deprivation=1 and high deprivation=10)^{16, 17} given our goal of ensuring improved access to ABPM within all communities.

Study Procedures:

The Nemours Institutional Review Board approved this study before the initiation of study procedures. Parents and patients were consented and assented on-site to take part. To ensure consistency in measurement, a dedicated clinic nurse (DCN) was responsible for obtaining the manual blood pressure. The DCN was also responsible for educating families about the study, placing the ABPM device, and instructing the patient and family on how to care for the device. Patients were asked to wear the device for 26 hours (1 hour for start-up and 1 hour for take-down time) and to return the device by mail (e.g., via a provided FedEx envelope) or in person to the site. Patients were encouraged not to remove the device during sleep and were allowed to take part in all activities, including sports. ‘Point of care ‘ABPM devices were provided within the primary care setting at no added cost to the patient/parent.

The ABPM device was set to inflate and deflate every 30 minutes during the day and every 60 minutes at night. Patients were provided with a diary to record sleep times. This diary was collected at the time of the device’s return. Once returned, the ABPM device was connected to a computer within the primary care practice and data from the device was uploaded into the Sentinel data platform (Downers Grove, IL). A single provider (CBS) read the APBM data and reported the results. The ABPM device wear results were sent to the referring provider in the electronic health record (EHR) within 72–96 hours of the device’s return. Management recommendations, including diet¹⁸, sleep study, referral for an echocardiogram, subspecialty referral (e.g., Nephrology or Cardiology), and recommended time to repeat APBM device wear were provided in the report. Primary care providers then contacted their patients with the final ABPM report, management and follow-up recommendations.

Trained study coordinators (JG and BH) collected patient demographic data from the EHR for each patient. The patient’s address was used to find the patient’s local and national ADI.^{16, 17} The study primary investigator (CBS) confirmed the accuracy of all data collected.

Results Reporting:

All patients received results of the ABPM device wear from their primary care provider. Regardless of the ABPM results, patients were educated on the importance of adhering to a low salt diet and consuming fruits and vegetables (e.g., DASH diet). Given that this study aimed to assess the acceptability, feasibility and tolerability of ABPM device placement within a busy primary care practice site, detailed dietary history was not captured due to the additional time required to collect these data during ABPM device placement.

Qualitative Interviews:

A subset of 25 patient-parent dyads were invited to complete individual, semi-structured, qualitative interviews via Microsoft Teams after patients wore the device and results were communicated to the family. Maximum variation purposive sampling¹⁹ was utilized to capture a full range of experiences and perspectives. Separately, all 7 primary care providers at Nemours Jessup Street Clinic and the DCN were invited to complete individual, semi-structured, qualitative interviews via Microsoft Teams. A separate consent/assent was obtained for interview participation. Each interview lasted 15–20 minutes. Interviews were audio recorded, transcribed, and uploaded into Dedoose (Redondo Beach, California) for qualitative coding and analysis.

Data Analysis:

Descriptive statistics were used to summarize participant demographic data. Qualitative data were analyzed using an inductive thematic approach.²⁰ Four patient, four parent, and two provider interview transcripts were independently coded by three raters (ES, VZ, BH) to establish inter-rater reliability. After achieving acceptable reliability (pooled Cohen’s kappa coefficient: patient/parent interviews: 0.86; provider interviews: 0.89), the remaining transcripts were divided among the raters for coding.

Compensation:

Patients and parents were not compensated for ABPM device wear, and providers were not compensated for study participation. However, each patient and parent who completed the qualitative interview was compensated $25 after the interview.

RESULTS:

Quantitative Results

Of the 62 patients offered ‘point-of-care’ ABPM between 6/30/2023 and 10/2/2024, 60 (97%) accepted. Sixty completed at least daytime wear and 58 (97%) completed night-time device wear. The median number of blood pressure recordings was 33 (IQR: 27.5, 37). The two patients who did not accept ‘point-of-care’ ABPM asked to return on another day to have the ABPM device placed due to scheduled athletic games. However, neither returned for ABPM device wear, even after two reminder calls.

Of the 60 with at least daytime ABPM data, 28 (47%) were male with a median age of 14 (IQR: 12, 16). The majority were Black (N=55, 92%) and of non-Hispanic ethnicity (N=59, 98%). Most were insured via public insurance (N=43, 72%). The median ADI of the children and adolescents was high, with a median local ADI of 9 (IQR: 7, 10) and a median national ADI of 67 (IQR: 55, 83).

Qualitative Interview Results

Twenty-five patients (11 males, 14 females) completed interviews about their experiences with ABPM (N=24 via Microsoft Teams and N=1 in-person). Two patients were siblings, resulting in 24 completed parent interviews (22 mothers, 1 father and mother pair, and 1 grandmother). Patients and parents who took part in interviews did not differ from the larger study sample in demographic or clinical characteristics. Provider interviews were completed by all seven primary care providers and the DCN. Qualitative themes were identified within the following categories: a) factors affecting decision-making, b) barriers to tolerability, c) confidence in results, and d) comfort with follow-up recommendations (Table 1).

Table 1:

Qualitative Themes Identified from Patient, Parent, and Provider Interviews

Categories/Themes	Representative Quotes
Factors Affecting Decision-Making
Importance of early HTN detection	• “I thought it was cool because it could help me a lot to see if I was okay and stuff like that. Like knowing that I had to manage my high blood pressure…I wanted to know my blood pressure was okay, and I was healthy.” Child 6 • “Once I gained some knowledge about it, I was all for it…Because my best interest was to diagnose my child and go about how we can move forward with the results. So, I just wanted to know if she had hypertension.” Parent 3 • “[With ABPM] We are less likely to miss a diagnosis of hypertension and to hopefully catch it early and prevent long-term damage.” Provider 7
Perceived benefits and convenience of ABPM	• “I thought it was good to get my blood pressure checked for the whole day…I feel it gives more accurate readings than just one time…it does it multiple times for 24 hours.” Child 19 • “I thought it was convenient and easy. We didn’t have to come back three more visits, or two more visits and it fit with my schedule and [child]’s schedule as well… I don’t have to take off from work. I don’t have to use my PTO.” Parent 23 • “Our patients have a difficult time getting up to the hospital and there are times where we can place [ABPM] same day, in our office essentially located in [their] community. So, it’s much easier for them.” Provider 1
Concerns about discomfort/activity restrictions	• “I had mixed emotions. Not really wanting to do it but feeling okay with doing it. It was just about it being on my body, like the placement and not wanting to have it shown.” Child 38 • “The main concern that I had was how invasive it would be…they explained to me, it was just like a regular blood pressure cuff. And you know, the only thing is, she would have to feel it going, pumping up and things occasionally, I was okay with it because I realized, it’s not going to cause her any harm. No bruising. They don’t have to insert anything.” Parent 9
Dialogue with/trust in primary care providers	• “We had a conversation like this is one thing that can help with blood pressure and if you don’t like it, you can take it off…she said, we do need the results.” Child 2 • “I did [have questions], you know, how long did he have to wear it? Would it be comfortable for him at night because he is a tossed and turner. Is he still able to do and go on about his regular routine with the monitor on him? They just told me that my child could go throughout his day like it was not even there.” Parent 2 • “It went well. I didn’t really have too many questions. I’ve been affiliated with this doctor’s office since I was a baby so and I trust them.” Parent 1
Barriers to Tolerability
Physical discomfort (15 patients, 17 parents)	• “It was uncomfortable and annoying on my arm…kept getting tighter and tighter.” Child 4 • “It was uncomfortable throughout the day, mostly at night. Because if I’m trying to sleep, it’ll just go off periodically…it was just at nighttime where it just got really difficult and uncomfortable.” Child 38 • “With him trying to sleep with it on and it squeezing his arm so that, he wasn’t comfortable with that, he kept asking numerous times: Like can I take it off?” Parent 2
Emotional discomfort (11 patients, 10 parents)	• “[It was] scary and uncomfortable. Because it kept shocking me. Like when it turned on, it was shocking me.” Child 28 • “It’s just, you have to worry about it too much. Like that day, I had to go to my dentist appointment, and it was buzzing inside the thing which made me kind of feel kind of embarrassed.” Child 23 • “She went to school with it, but she was feeling some type of way, like, what if they make fun of me or something like that.” Parent 29
Bulkiness/placement of the device (5 patients, 10 parents)	• “It was just annoying because there was this big block piece as I walk around my arm. The big block piece and one other thing, it is just too big.” Child 40 • “The wire….everything he tried to do, like make food or walk the dog…everything was getting in the way of the wire because it hung down so low and it couldn’t like strap against his body to stop it from moving.” Parent 23
Suboptimal fit (6 patients, 8 parents)	• “Sometimes like it’ll be too tight on my arm, so when I adjusted it, it will feel like kind of like fall down.” Child 14 • “I just kept re-strapping it and re-fixing it…because he was playing around the house with his brother and just sitting around or moving around, [it] kept loosen up, and I got to keep like strapping it.” Parent 45 • “When she first got here it slipped off, it came loose and she came straight to me, and she was like “mom, can you tighten it back up because it’s loose” So it does loosen up when they’re wearing it consistently so I did have to tighten in like 3 or 4 times from it loosening up.” Parent 6
Technological difficulties (3 patients, 2 parents)	• “It stopped showing the numbers after a certain point throughout the night and we didn’t know if it was monitoring 24 hours or not…It never came back on, but they said they had the numbers. It did monitor throughout the night, it’s just that you couldn’t view it.” Parent 48
Suggestions to Improve Tolerability
Optimizing fit, placement, and/or design of device (9 patients, 7 parents)	• “To be honest it would be making it little bit smaller because keep people attention. Something like keep it in the pocket.” Child 12 • “The only thing I would say is find a way for the cuff not to slip off so much. Like if you could do a little double-sided tape or something on there so it won’t flip down so much. I think that will work a lot better.” Parent 6 • “Make it a little bit easier, the contraption itself, maybe smaller, wireless, Bluetooth or something like that. I’m not sure exactly, but I think how needed it to be carried was a little annoying to them.” Parent 16
Requiring <24 hours of continuous wear (0 patients, 6 parents)	• “That it wouldn’t be 24 hours and it would register what they were looking for in a shorter amount of time, that would be great.” Parent 48 • “Just how long he has to wear it, if maybe like certain times. He’s a teenager and teenagers are going to be teenagers, so I just think not the full 24 hours. Sometimes the doctors say, “I want to your blood pressure reading AM/PM or before breakfast or after breakfast”. Maybe if it was more of those instructions.” Parent 23
Planned timing of wear (0 patients, 3 parents)	• “He wouldn’t wear it at school. I guess like a Friday type situation where you can do it overnight and not have to worry about taking it to school.” Parent 1
Less cuff tightening (3 patients, 0 parents)	• “Not getting tighter every time it goes on.” Child 4
Confidence in Results
Multiple blood pressure readings in comfortable environment	• “I feel very comfortable with the results because the simple fact like he was in his own environment versus if he goes to see his pediatrician, he may have that anxiety that makes his blood pressure rise a little bit because it’s a different environment for him but when he’s at home, he’s in his relaxed zone, so he’s in his comfort zone.” Parent 2 • It gets multiple readings while you’re awake and asleep, and therefore gives you more reliable data. I think it’s a good tool to have for diagnosing hypertension. Provider 6
Consistency with clinical picture and family history	• “I was confident. High blood pressure does run in my family, so it’s not like I was a super shock because I’ve always had it like in the back of my mind that it possibly could happen for one of my children. I was satisfied with the results.” Parent 19
Trust in primary care providers	• “I was confident. Because I have a good relationship with her doctor. He’s been her pediatrician since she was born. And he was also my other two older children pediatrician as well.” Parent 38
Comfort with Follow-up Recommendations
Perceived importance of recommendations	• “She told me to get a better diet, exercise, better sleep and just like do things that help my health basically. I feel like those recommendations would work, because those are areas I do have to work on.” Child 48
Timeliness of follow-up appointments	• “[I was told] that my child had high blood pressure, and he needed to go in for several testing [appointments] and I will be getting contacted to set up those appointments… [I feel] very comfortable. We have two appointments set up already.” Parent 5

Factors Affecting Decision-Making

Four themes related to decision-making and ABPM were identified from the patient and parent interview data: 1) the importance of early HTN detection, 2) the perceived benefits and convenience of ‘point of care’ ABPM, 3) concerns regarding activity restrictions and discomfort, and 4) dialogue with/trust in primary care providers (Table 1). Patients and parents wanted to know about a potential health issue (e.g., HTN) early and understand the next steps to address it. This was often framed within the context of a family history of HTN. Several parents noted perceived benefits of ‘point of care” ABPM, such as measuring blood pressure in a comfortable home environment, increased accuracy with 24 hours of blood pressure readings, and not having to take off from work to attend additional clinic visits. Some concerns about activity restrictions, anxiety, or self-consciousness were reported. Patients and parents described an open dialogue with and trust in their primary care providers and noted that their questions and concerns were adequately addressed.

Providers reported offering ABPM to most of their eligible patients. Still, in a few cases, providers stated that they did not offer the ABPM device to youth for whom the appropriate cuff size was not available, when a child was ill, or when the provider perceived that the patient would not adhere with ABPM or appropriately care for and return the device. Two similar themes related to provider decision-making were identified: 1) the importance of early HTN detection and 2) the perceived benefits and convenience of ‘point of care’ ABPM.

Barriers to Tolerability

Five themes corresponding to ABPM tolerability were identified: 1) physical discomfort (e.g., cuff tightening, irritation), 2) emotional discomfort (e.g., self-consciousness, anxiety), 3) bulkiness and placement of the device, 4) suboptimal fit, and 5) technological difficulties.

The most common barrier to ABPM tolerability reported by patients (36%) was the sensation of the cuff tightening, which was described as frequent, uncomfortable, and, in some cases, painful. This appeared particularly difficult for patients to tolerate at nighttime. Some patients also reported experiencing anxiety (28%) or general irritation/discomfort (24%) while wearing the ABPM. The most common barrier to ABPM tolerability reported by parents (42%) was that the device got in the way of routine activities, given its placement on the child’s arm and the attachment of the device to wires. Parents reported that their child felt self-conscious (33%; e.g., at school, in public, with siblings), and a few parents noted that they kept their child home from school on the day of the device wear.

Providers perceived similar barriers to tolerability for their patients, specifically the frequency of cuff tightening, general discomfort, and self-consciousness, particularly at school. Of note, although these barriers were described as negatively affecting device tolerability, they generally did not affect adherence, with most patients and parents reporting that the device was worn for the full 24 hours (97%).

Patients and parents offered suggestions for improving device tolerability. The most common suggestions patients (36%) and parents (29%) made to improve ABPM tolerability involved improving the fit, placement, and design. Specifically, they suggested it should be less bulky, wireless, and the cuff designed to minimize slippage. Providers recommended ensuring the availability of proper cuff sizes. Some parents (25%) recommended wearing the ABPM for less than 24 hours to improve tolerability.

Confidence in Results

Parents and all healthcare providers reported high confidence in ABPM results, with no reported barriers to acceptance of results. Both parents and providers attributed their confidence to the multiple blood pressure readings obtained over 24 hours in a comfortable and familiar environment. Many parents also noted that the results were consistent with information they had received previously (i.e., high blood pressure readings during prior clinic visits). Some parents said that their trust in their child’s primary care provider and the overall health system influenced their trust in the results. In cases where sustained high blood pressure was not detected via ABPM, parents described the results as “reassuring.”

Comfort with Follow-up Recommendations

Many patients and parents reported comfort with follow-up recommendations. This was attributed to 1) the perceived importance of recommendations and 2) the timeliness of follow-up appointments. Patients and parents often noted that the recommendations (e.g., pediatric cardiology, sleep study, lifestyle modifications) seemed appropriate and important within the context of ABPM results, although some patients acknowledged the difficulty of making changes in their diet. Providers noted that their conversations with parents about recommendations for follow-up tended to be straightforward, given the “definitive” nature of the results and relatively clear next steps.

DISCUSSION:

ABPM is the gold standard for confirming a diagnosis of HTN in US children and adolescents.^{8, 12} The data is accurate and reproducible.^{8, 12} However, access, cost, and perceptions of poor tolerance have limited ABPM use.¹⁴ In this study, we addressed all three barriers and assessed the feasibility of ‘point of care’ ABPM. We feasibly made ABPM accessible within the primary care setting at no added cost to the patient/parent. We assessed patient, parent, and provider response to the device, including perceptions of device tolerance. The result was 97% acceptance. Though tolerance was a concern, it did not limit device wear in most patients.

By making ABPM available within the primary care setting, we addressed patients’, parents’, and primary care providers’ uncertainty concerning in-office blood pressure measurement and HTN diagnosis. Patients, parents, and providers reported greater confidence in the HTN diagnosis following ‘point of care’ ABPM. For example, one child said: “I thought it was good to get my blood pressure checked for the whole day…I feel it gives more accurate readings than just one time…it does it multiple times for 24 hours” [Child 19]. Parents reported greater comfort that anxiety was removed as a cause of the child’s elevated blood pressure: “I feel very comfortable with the results because of the simple fact that he was in his own environment versus if he goes to see his pediatrician, he may have that anxiety that makes his blood pressure rise a little bit because it’s a different environment for him, but when he’s at home, he’s in his relaxed zone, so he’s in his comfort zone” [Parent 2]. Providers liked that they could receive multiple blood pressure measurements: “It gets multiple readings while you’re awake and asleep, and therefore gives you more reliable data. I think it’s a good tool to have for diagnosing hypertension” [Provider 6].

‘Point of care’ ABPM addresses providers’ concerns about improper in-office blood pressure technique contributing to a false positive diagnosis of HTN and provides reliable access to out-of-office blood pressure readings.^{5, 6} The 2017 CPG recommends repeat in-office measurements and regression toward the mean to avoid false positive diagnoses.⁸ Other options for repeat blood pressure assessment, such as referral to a pharmacy blood pressure monitoring kiosk, home blood pressure measurement, repeat blood pressure measurement by the school nurse, or subspecialist referral, are fraught with their own challenges. Less than 70% of youth return for repeat in-office blood pressure measurements within the recommended time frame.³ In a large quality improvement trial, only 2% of individuals 3 to 22 years old completed all recommended blood pressure measurements.⁴ Even with education and electronic decision support tools, recognition of abnormal blood pressure is not sustained.²¹ Pharmacy kiosks are not validated for youth blood pressure assessment.²² Blood pressure measurements by the school nurse occur “sometimes” but only 19% of nurses report having enough time to complete all necessary tasks.²³ Time to referral for subspecialist evaluation may be 6 months or more.²⁴ Home blood pressure assessment is another option, but Food and Drug Administration-cleared pediatric devices are limited, as are validated protocols for blood pressure assessment in youth. Yet providers recognize that they cannot treat what they have not diagnosed. “(With ABPM) we are less likely to miss a diagnosis of hypertension and to hopefully catch it early and prevent long-term damage.” [Provider 7].

Although patients, parents, and providers touted the benefits of ‘point-of-care’ ABPM, there were appreciable concerns about device comfort and recommendations for enhanced design. “It was uncomfortable and annoying on my arm…” [Child 4]. “… making it a little bit smaller” [Child 12] and “...find a way for the cuff not to slip off so much…I think that will work a lot better” [Parent 6]. However, these barriers did not affect patient adherence to ABPM wear. Patients, parents and providers generally felt that the information obtained from the ABPM was more useful than any experienced discomfort.

In summary, ‘point of care’ ABPM may foster improved HTN diagnosis confirmation within the pediatric primary care setting. It may help alleviate some of the uncertainty experienced by providers about the significance of elevated in-office blood pressure. Despite the challenges associated with ABPM device wear, patients, parents, and providers recognize the benefits of ‘point of care’ ABPM. “Point of care’ ABPM reduces the proportion of children and adolescents with incomplete diagnostic evaluation for HTN and addresses parents’ and providers’ concerns about diagnosing HTN without out-of-office blood pressure assessment. As a result, providers were encouraged to act sooner and more confidently to address the blood pressure.

Limitations:

Our study is single-site, and we do not yet know if ‘point of care’ ABPM can be feasibly employed across a range of practice sites and health systems. However, we are actively investigating this potential. ABPM is still a costly and limited resource. Yet, device availability and cost may improve with more data to support its use. Fortunately, we could secure funds to buy these devices for our study. Other health systems and practices may be able to do the same. Children and adolescents expressed discomfort with the current device design, but with added product development, better fitting and more comfortable devices may enter the market. Finally, our study was a pilot study designed to assess the feasibility and tolerability of ‘point-of-care’ ABPM. Thus, we purposely limited the request for patients’ information at the time of ABM device placement. In future studies, we can consider adding additional questionnaires such as detailed diet information and sleep habits.

Conclusion:

‘Point of care’ ABPM may be an acceptable and feasible approach to improved HTN diagnosis confirmation in the pediatric primary care setting. Due to the potential for earlier detection and early intervention, ‘point of care’ ABPM may also help to reduce the long-term burden of hypertensive cardiovascular disease.

Abbreviations and Acronyms:

ABPM

Ambulatory blood pressure monitoring

HTN

Hypertension